Learning Collaborative
 
December 18, 2020
The Dish
The Dish provides a monthly update to participating sites enrolled in the MQii Learning Collaborative.
 
 
 
SPOTLIGHT: PREVIEW OF 2021

As we approach the start of 2021, we would like to share with you several updates about plans for the MQii Learning Collaborative:
  • We are updating the MQii Toolkit and website to be more user-friendly and better align with the Nutrition Care Process, based on feedback we have received from members
  • We are interested in the topic of enhanced recovery after surgery (ERAS) and are seeking to identify (1) sites that are already engaging in efforts related to nutrition in ERAS and/or (2) sites that have an interest in and are planning to engage in efforts related to nutrition in ERAS. If this is true of your site, please provide us with a brief overview of your efforts by emailing us at [email protected]
  • We will continue to hold monthly Coffee Breaks to share Learning Collaborative site insights and answer questions and will move to a quarterly distribution of the Dish, with periodic check-in and update emails as appropriate. We will highlight existing expert webinar recordings and promote relevant events hosted by our partner organizations in lieu of providing new expert webinars
  • Finally, we are moving to a self-enrollment form for all non-data-sharing members. Because your current agreements terminate on 12/31, we ask that you please fill out this brief self-enrollment form to continue to participate. For our data-sharing members, we will disseminate an updated addendum to your original agreement for you to sign, as you have signed in previous years, in early 2021
 
COVID-19 CORNER
 
 
As the pandemic continues, the MQii Leadership Team is compiling resources about responding to COVID-19 for Learning Collaborative members. Here are a few resources and updates that may be of use to you during this time:
REQUEST FOR READERS

We are conducting a brief survey to gather information about whether and how you have expanded your QI projects to other sites in your healthcare system. Thank you to those who previously responded to this request. If you haven’t already done so, please respond with answers to the following questions to [email protected] by 12/31:

1. What is the name of your facility?
2. Is your institution part of a health system? If so, which one?
3. Did you expand MQii participation to other facilities in your health system?
  • If so, how many facilities and what are their names?
  • If not, what are the primary barriers to doing so?
4. Do you plan to expand MQii participation to other facilities in your system in 2021?
  • If so, how many facilities and what are their names?
  • If not, what are the primary barriers to doing so?
WHAT'S AROUND THE CORNER?
Please check the MQii Learning Collaborative Calendar to see a schedule of upcoming events with corresponding registration links.
Coffee Break: “New Goals for Malnutrition Quality Improvement in 2021” | Thursday, January 21, 2021, at 2:00 PM ET

In light of the current healthcare climate, we would like to offer this time for Learning Collaborative members to discuss with one another their plans for updating their malnutrition QI projects or possibly beginning new ones in 2021 to best improve patient care. 

Please register for the Coffee Break in advance here. 

For all of our expert webinars and Coffee Breaks, we encourage you to send any questions for the speakers in advance to [email protected].
In case you missed it:

If you missed previous MQii Learning Collaborative expert webinars, you can access webinar recordings and slides on the MQii Member Portal. You will also find other member-only content, including the calendar of upcoming events, pre-recorded educational webinars, and archived Dish newsletters, on this site. As a reminder, the login information is: Username: MQii Password: MQiiLC2018!
Consider opportunities to share your MQii project and findings!

The following table outlines several meetings and conferences that may be of interest to Learning Collaborative members in the coming months. We encourage you to look at the event websites, review submission criteria, and consider sharing your research with these various audiences. Please reach out with any questions or for assistance in pulling together submission materials.
 
 
 
LEARNING COLLABORATIVE PARTICIPANT RESOURCES

New MQii-Related Publications

Phillips et al. recently published a paper, titled “Comprehensive Application of the Malnutrition Quality Improvement Initiative (MQII) Toolkit to Pediatric Malnutrition Care,” in JAND. This publication provides guidance for dietitians specializing in pediatrics to implement malnutrition quality improvement projects leveraging MQii Toolkit resources and materials. It also evaluates the 4 malnutrition electronic clinical quality measures (eCQMs) in the pediatric population to support improved patient care and outcomes. As some of our Learning Collaborative members have expressed interest in using the Toolkit in different patient populations and settings of care, this article could provide useful guidance for undertaking such efforts in the pediatric setting.  

The MQii Leadership Team also collaborated with Dr. Albert Barrocas and Dr. Anne Utech to publish a paper in the Physician Leadership Journal, titled, “The Critical Importance of Integrating Malnutrition Care into U.S. Healthcare.” The authors provide an overview of the importance of addressing malnutrition and the distinct but related efforts of the Veterans Health Administration and the MQii models for physicians and interdisciplinary colleagues to lead malnutrition-focused QI projects to improve patients’ health. This article appeared on the journal’s website on December 16.

New Nutrition-Related Podcast

The Avalere leadership team recently recorded a podcast about the importance of medically tailored meals (MTMs) for improving food insecurity and poor health for community-dwelling and medically complex individuals. The discussion included how MTMs relate to health outcomes and healthcare costs as well as opportunities to expand reach through health plans. This podcast featured Kim Madsen, the Director of Nutrition Services at Project Open Hand, and David Waters, CEO of Community Servings. This podcast will be released on December 22 on Avalere's podcast website. We look forward to more opportunities to produce podcasts about nutrition-related topics in 2021.

NFPE “Tip of the Month” 

Tips for a Visual NFPE During the Current Health Crisis, When Unable to Perform an NFPE With Hands-On Techniques
  • If performing a visual NFPE assessment, document energy intake and weight history in detail (if available) and provide the visual NFPE assessment as supportive data, along with labs, tests, and other pertinent information in the medical record
  • Connect with patient’s family, caregiver, or previous facility to discuss how he/she was eating and if previous weight(s) are available
  • When discussing visual NFPE findings, look for more than one visual finding to indicate wasting due to inadequate nutrition/malnutrition. Examples of visual findings include:
  • Bilateral sunken temples for temporalis wasting
  • Protruding clavicle for pectoralis wasting
  • Squared shoulders for deltoid wasting
  • Remember to utilize clinical judgement; step back and look at the whole picture
  • If data are not sufficient to identify malnutrition, monitor whether more data become available to support the nutrition diagnosis (i.e., document that the patient is at risk for malnutrition due to “XYZ” and continue to monitor to provide ongoing nutrition assessment, diagnosis, and intervention)
MALNUTRITION IN THE NEWS

The connection between malnutrition and COVID-19 was featured in a recent news article titled, “It’s Your Health: Malnutrition a Health Concern for Older Adults.” Author Laura Falt noted that while malnutrition was already a serious health issue for seniors, the pandemic has made it worse. After reviewing factors that contribute to malnutrition (such as isolation and new medical conditions) and resulting health problems, the article shares resources available in the local community of Middlesex County to help to ensure seniors can consume nutritious meals. This story offers an example of one way to present evidence-based information, raise awareness among the public, and direct readers to useful resources; Learning Collaborative members may wish to highlight similar efforts and local resources via visibility efforts in their own region.
MALNUTRITION RESEARCH

Allepaerts et al. recently published a paper titled, “Clinical Impact of Nutritional Status and Energy Balance in Elderly Hospitalized Patients,” that investigated the connection between elderly patients’ nutrition status, energy requirements, and outcomes. In this prospective cross-sectional study, the authors aimed to 1) assess the nutritional status of patients hospitalized in a geriatric ward using the Global Leadership Initiative on Malnutrition (GLIM) criteria, 2) determine the balance between energy intake with an enriched diet and energy requirement using indirect calorimetry, and 3) assess whether undernutrition is associated with patients’ outcomes after 1 year. They found that 27% of these patients were undernourished, which was associated with increased 1-year mortality but not with institutionalization. Further, they found that energy requirements were higher in patients who were undernourished and had a low BMI. The authors concluded that enriched energy intake could meet these patients’ needs, indicating the importance of ensuring accurate and thorough assessments and diagnoses to be able to provide needed care and food resources for such patients.  
NEXT STEPS
  • For our non-data-sharing members, sign and return your self-enrollment form to participate in the Learning Collaborative after 2020 as soon as possible
  • Visit the COVID-19 page on our website for more resources 
  • Attend the upcoming January 21 Coffee Break if you have questions regarding your malnutrition quality improvement efforts or want to discuss new or continuing malnutrition initiatives 
  • Share your progress or reach out with any questions to your MQii Point of Contact. Please also let us know about any transitions in leadership, requested topics for future events, or additional events of interest to share with other members